TeleHealth Benefit Program Enrollment
Step 1
Complete the Census Form. List all employees and indicate whether they are participating.
Step 2
Each participating employee completes the Application.
Step 3
Complete the Agreement for List Billing.
Return all completed documents to:
TBA Member Insurance Solutions
6505 Lee Highway
Chattanooga, TN 37421
Fax: 866.791.2806
Email: TBA@assoc-admin.com